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Download Morbidity Definition Template, Summer 2014
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Morbidity Definition Template, Summer 2014. -----------------------------------------------------------------------------------------------------------1. Morbidity name: Hospital acquired Infection (HCAI) -----------------------------------------------------------------------------------------------------------2. Natural timescale for identifying morbidity (e.g. within 7 days of operation, before discharge from hospital, within 1 month of operation etc): For most HCAIs, they would be identified and diagnosed within the hospital admission by a positive laboratory result with clinical symptoms of an infection. For surgical site infections (including Infective Endocarditis, IE) the recommend time scale by NICE is 28 days. There are a few exceptions and late onset SSIs can occur after 28 days post operatively -----------------------------------------------------------------------------------------------------------3a. Do suitable standard, accepted, definitions exist that can be used? Yes. Definitions ( epic3: National Evidence-Based Guidelines for Preventing HealthcareAssociated Infections in NHS Hospitals in England, Journal of Hospital Infection Volume 86, Supplement 1 , Pages S1-S70, January 2014) Bacteraemia The presence of microorganisms in the bloodstream Bacteriuria The presence of microorganisms in the urine. If there are no symptoms of infection, this is called ‘asymptomatic bacteriuria’ Bloodborne virus A viral infection transmitted by exposure to blood and sometimes other bodily fluids. Bloodborne viruses include hepatitis B and C as well as human immunodeficiency virus Bloodstream infection (BSI) The presence of microbes in the blood with symptoms of infection Catheter-associated urinary tract infection (CAUTI) The presence of symptoms or signs attributable to microorganisms that have invaded the urinary tract, where the patient has, or has recently had, a urinary catheter Catheter colonisation Microorganisms present on a surface of a catheter that could potentially lead to infection Catheter-related bloodstream infection (CR-BSI) An infection of the bloodstream where microorganisms are found in the blood of a patient with a central venous access device, the patient has clinical signs of infection (e.g. fever, chills and hypotension) and there is no other apparent source for the infection. For surveillance purposes, this often refers to bloodstream infections that occur in patients with a central venous access device and where other possible sources of infection have been excluded. A more rigorous definition is where the same microorganism is cultured from the tip of the catheter as grown from the blood; simultaneous quantitative blood cultures with at least a 5:1 ratio of microorganisms cultured from the central venous access device vs peripheral; differential time to positivity of at least 2 h for blood cultures cultured peripherally vs from central venous access device Catheter-related infection Any infection related to a central venous access device, including local (e.g. insertion site) and systemic (e.g. bloodstream) infectio Colonisation Microorganisms that establish themselves in a particular environment, such as a body 1 Last updated: 08 May. 17 by: Christina surface, without producing disease Gram-negative/positive bacteria The type of bacteria as identified by Gram's staining method. Gram-positive bacteria appear dark blue or purple under a microscope. Such bacteria have a thick layer of peptidoglycan on their cell walls. Gram-negative bacteria appear red under a microscope and have an outer layer of lipoprotein and a thin layer of peptidoglycan Healthcare-associated infection (HCAI) Infection acquired as a result of the delivery of health care either in an acute (hospital) or non-acute setting Infection Microorganisms that have entered the body and are multiplying in the tissues, typically causing specific symptoms Meticillin-resistant Staphylococcus aureus (MRSA) Strains of S. aureus that are resistant to many of the antibiotics commonly used to treat infections. Epidemic strains also have a capacity to spread easily from person to person Severe acute respiratory syndrome (SARS) A severe form of pneumonia caused by a coronavirus Urinary tract infection (UTI) The invasion of the tissues of the bladder by microorganisms causing symptoms or signs of infection such as dysuria, loin pain, suprapubic tenderness, fever, pyuria and confusion MRSA: Public Health England- PHE (formerly the Health Protection Agency) has been managing, on behalf of the Department of Health, the mandatory surveillance of Staphylococcus aureus bacteraemia in England since April 2001. The following aggregated data ("quarterly lab returns") are also collected as part of this surveillance scheme: Total blood culture sets examined (a sample arising from a single venepuncture, irrespective of the number of bottles tested) Total number of positive blood cultures (all positive results for bacterial growth, including repeat specimens and contaminants) Positive blood cultures from the same patient within 14 days of the initial culture are considered to be part of the original episode and should not be reported. Duplicate reports, more than 14 days apart should be reported as these are considered to be a separate episode. Evidence Base criteria for diagnosing infections: SSI- NICE guidance, 2014 Central venous catheter blood stream infections- matching Michigan 2014 C diff- Everyone Counts: Planning for Patients 2013/14: Technical Definitions, commissioning board, s h e a - i d s a g u i d e l i n e, 2010 Norovirus- Guidelines for the management of norovirus outbreaks in acute and community health and social care settings, 2012, HPA MRSA- Everyone Counts: Planning for Patients 2013/14: Technical Definitions, commissioning board, PHE Microbiology Services Colindale Bacteriology Reference Department User Manual APRIL 2014 -Guidance on the diagnosis and management of PVL-associated Staphylococcus aureus infections (PVL-SA) in England, 2008, Health Protection Agency MSSA2 Last updated: 08 May. 17 by: Christina Urinary tract infections- diagnosis of UTI- Quick reference guide for Primary care, HPA, 2011 Catheter related urinary tract infectionsVentilator acquired infectionsRespiratory infectionsMulti drug resistant organism- Guidelines for the Prevention and Control of Multi-drug resistant organisms (MDRO) excluding MRSA in the healthcare setting, 2012 (Published on behalf of the Royal College of Physician’s clinical advisory group on Healthcare Associated Infections inassociation with HSE Quality and Patient Safety) -----------------------------------------------------------------------------------------------------------3b. If no (or partially no) to part 3a – can you outline a general strategy for how this morbidity would be identified/diagnosed/monitored? (detailed definitions are not needed until final 10 morbidities have been chosen, but it is helpful to have some thoughts on this). -----------------------------------------------------------------------------------------------------------3c. Do the definitions encompass morbidities directly attributable to surgery or to presence post-surgery (regardless of cause) (During panel meeting, we discussed potentially having definitions for both “attributable” morbidity & “present” morbidity, or choosing one or the other). Attributable: SSIs, blood stream, urinary catheter, vascular access device, ventilator acquired, Present: UTI, respiratory infections, gastro-intestinal diseases -----------------------------------------------------------------------------------------------------------4. How feasible is it to monitor this morbidity for EVERY cardiac paediatric patient (morbidities to be identified within 4-6 weeks following surgery for THIS project)? (e.g. what are the resource/staffing implications? Is there any subjectivity involved? Are timescales suitable?) Some HCAI are already collected: “Mandatory reporting of methicillin resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium difficile infection (CDI) has been in place for National Health Service (NHS) acute Trusts for several years. Independent Sector (IS) hospitals began reporting MRSA bacteraemia and CDI, from January 2008. In January 2011 this scheme was extended to include surveillance of MSSA bacteraemia and E. coli bacteraemia in June 2011. IS healthcare organisations providing regulated activities undertake surveillance on HCAIs and report to Public Health England (PHE) as specified in the Code of Practice. Please refer to the UK Legislation website and The Health and Social Care Act 2008 for more information.” Taken from 3 Last updated: 08 May. 17 by: Christina http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HCAI/Epidemiological DataHCAI/hcaiISreportingintro/ Would be able to collect all data required at 4-6 weeks postoperatively. Resource required to go through all patient records to identify is clinical and laboratory evidence of infection Mandated reportable HCAI (already collated and submitted): MSRA bacteraemia, MSSA bacteraemia, E-Coli bacteraemia, C-Diff, SSIs (inc IE) Infections that should be internally reported: All positive cultures from clinical samples Infections that would be identifiable from review of patient records: Respiratory, Urinary catheter, vascular access device, ventilator acquired, -----------------------------------------------------------------------------------------------------------5. Any comments on whether this morbidity is a possible consequence of an another morbidity that we are also considering? (e.g. Developmental delay – neurological injury – these considerations may help the selection panel in its final selection) Other morbidities that might affect HCAI Length of stay- more exposure to infections Problems feeding- NG/NJ/Gastrostomy increase the risk of infection ECMO/Mecahnical support- increased risk of infection Unplanned reintervention/re-operation- increased risk of infection Length of ICU stay- more exposure, if requiring multiple lines/investigations/invasive monitoring/procedures then high risk -----------------------------------------------------------------------------------------------------------6. Any other comments for the selection panel? SSIs- In the NICE guidance there are grades of SSI’s. These categorise the infection. 4 Last updated: 08 May. 17 by: Christina